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I recieved this psot on parent-l and was hoping some Lactnetters
would post a response!

At the recent ISRHML (International Society for Research on Human
Milk and
Lactation) meeting in Mexico, someone from the CDC spoke with us
about
guidelines being formulated for the handling of expressed human milk
in the
day care setting.  The concern is that milk from HIV-infected mothers
could
pose a risk to the day care providers or to other children (if the
bottle was
mixed up with another baby's bottle).  While the infectivity of
expressed human milk is quite likely to be almost insignificant, it
is a real
safety concern being addressed by OSHA and the CDC.

I would love to hear people's experiences and thoughts regarding the
handling
of expressed human milk in the day care setting.  I can forward
thoughtful
replys to the scientist in charge of formulating this policy.  Thanks
in
advance.

I deleted sender's name to protect his privacy as he has not
responded to my e-mail requesting permission to post this.


This was my reply:     To:
Subject: HIV, milk and day care

This is really a tough subject. I hope it will be examined
thoughtfully and in the proper context.  We are
already seeing day care providers who will not care for breastfed
babies nor accept milk in their day care
setting.

I see this as a human rights issue. It is not acceptable to ask the
HIV status of a child coming into day
care, nor to require testing prior to admission because if he is HIV
positive he could be discriminated
against.  This is in the same category as asking a mother is she is
HIV+ or testing her before accepting
her milk. Therefore, it is all a guessing game and a game of RISK.

What are the risks of HIV transmission through breastmilk in a day
care setting? The HIV virus has been
isolated from human milk (and saliva and tears and blood), but
transmission from breast milk is still
uncertain and not well proven. Probably an insignificant route of
transmission.  We know that breast milk
kills the HIV virus in a test tube, the antiviral properties would
probably destroy it in a bottle also. If the
milk has been frozen, minute risk is probably further reduced.  There
are no documented cases of
transmission of the HIV virus through expressed breastmilk, not even
any potential cases.  There are no
documented or suspected cases of transmission to day care workers or
other children in the day care
setting.  Therefore the risk is only hypothetical.

If we look at this in the context of HIV and the day care setting. It
seems that there are far greater
opportunities for exposure to HIV in the day care setting from blood
exposure.  Many young children get
scrapes and scratches and pick scabs and get bloody noses and nothing
will draw a flock of kids like
bright red blood. The risk of transmission in the day care setting
seems much higher from exposure to
blood.

If we look at this in the context of body fluids and exposure in day
care setting, we will see this risk in
another perspective.  There can may be daily exposure to other body
fluids: saliva, vomit, spit up, tears,
urine, nasal mucous, cough droplets and feces. Kids leak from every
orifice and they love to share their
fluids with their friends and caretakers. Will exposure to breastmilk
( a swig from the milk of an HIV+
mother) be an increased risk over child-to-child or caretaker-to-
child exposure?

If we look at this as an issue of infectious disease in the day care
settings, we may question the wisdom
of being overly cautious with breastmilk. There are germs in day care
settings and babies are glad to
share them with their friends on a regular basis.  They are in close
contact and have many opportunities
for exposure. Breast milk protects against some of the worst
infections that can be picked up from day
care.  Breastfed babies are healthier, therefore more breastfed
babies will bring fewer germs into the day
care setting, that by itself should encourage us to reduce barriers
to breastfeeding and providing breast
milk for children in day care. If a child is exposed to an infectious
agent, his breastmilk may decrease the
risk of development of the illness or may reduce the severity.  In
our community last year many babies got
day care transmitted respiratory synticial virus (RSV). Four children
required resuscitation and respirators.
None of the babies hospitalized in one hospital were breastfed.  This
disease kills babies and
breastfeeding is highly protective for this disease. If babies aren't
able to receive breastmilk in the day
care setting, the protection that breastmilk provides will diminish
and risk of infectious disease and illness
and death will increase.  These risks are known and not insignificant.
  Increasing barriers to providing
breastmilk in order to protect babies from theoretical risk of HIV
exposure will undoubtedly cause a
rebound of preventable illness.  I would be more concerned about a
baby picking up an unwanted microbe
from the owner and drinker of the bottle than from the donor of the
milk.

What guidelines would be appropriate? Hand washing after handling
breast milk, storage in a sealed
container-preferably the bottles it will be fed in to reduce spills
and transfer exposure, cautions about not
leaving bottles where another baby can pick them up.  Babies should
be held while being fed and should
not be allowed to wander around holding and throwing down their
bottles.

 Gloves may increase the discrimination against breastfed mothers and
babies unless gloves are worn to
handle all food and drink and when feeding all babies, separate
storage facilities may create barriers for
mothers and health care providers, although many mothers store their
milk with "blue-ice" in the diaper
bag. Requiring boiling or freezing of milk will destroy valuable
disease fighting antibodies.

Mothers should have the right to breastfeed their babies,
breastfeeding mothers should have the right to
work and find day care for their children and babies should have the
right to have breast milk even if they
are in day care. It is imperative that whatever regulations are
instituted these rights should be protected.
Cathy Liles, IBCLC